Smiles for life module 6

Mexican American, non-hispanic black, and lower socioeconomic status.

early childhood caries is most prevalent in which groups?

Upper incisors affected first, then first molars, then second molars (mandibular incisors generally not affected)

in what order are teeth affected by ECC?

bacteria, teeth, and sugars

-Bacteria metabolize dietary sugars into acids

-Acids demineralize tooth enamel

what is the triad for the etiology of ECC? what does this mean?

less frequent consumption of sugars

what can allow for more time for teeth to fully remineralize?

§ Pain

§ Impaired chewing and nutrition

§ Infection

§ Increased caries in permanent dentition

§ School/work absences/more likely to have poor school performance

§ Difficulty sleeping

§ Poor self esteem

§ Extensive/expensive dental work

what are some consequences of ECC?

Knee-to-knee

what method should you use for performing an oral examination on an infant or toddler?

White lines and white spots are the first signs of caries, then progress to larger brown cavities

what are early signs of caries on oral examination?

start at 6 months, do at every WCC

when should caries risk assessment tools be used?

twice a year for all children and 4 times a year for those at high risk

AAP recommends fluoride varnish how often?

AAP

what is the most widely used and easy to implement risk assessment tool for ECC?

the child is at an absolute high risk for caries

with the risk assessment tools, questions marked with yellow triangle mean what?

Caregiver with active tooth decay

Caregiver does not have a dentist

what are examples of items on the risk assessment tool that indicate an absolute high risk for caries?

having a dental home, tooth brushing, fluoride use

protective factors for dental caries

Plaque, gingivitis, brown or white spot lesions, evidence of treated decay

what are clinical findings that would place a child at an increased caries risk?

Inhibits demineralization and promotes remineralization, inhibits bacterial metabolism, reduces enamel solubility

effects of fluoride

toothpastes, gels, foams, mouthwashes, fluoride varnish

topical sources of fluoride

water fluoridation, dietary fluoride supplements

systemic sources of fluoride

starting at tooth emergence

when is fluoridated toothpaste indicated?

every 3-6 months starting at tooth emergence through age 5

when is fluoride varnish indicated?

if high risk and over age 6, if child can swish/spit

when is fluoridated mouth rinse indicated?

recommended for everyone

when is water fluoridation indicated?

if drinking supply is not fluoridated

when is dietary fluoride supplementation indicated?

§ Blot teeth dry with gauze

§ Apply varnish to dried teeth starting posterior, thin layer to all tooth surfaces

§ Apply to anterior teeth last (may need to modify if child is uncooperative since this is the highest risk teeth)

§ Saliva contamination is okay

procedure for fluoride varnish application

§ Teeth may be discolored for 24-48 hours. Avoid hot, sticky, and hard foods the rest of the day

post-procedure instructions after fluoride varnish

-Educate all staff on caries risk assessment and the importance of fluoride varnish

-Train clinicians on application procedures

-Identify a varnish champion who answers questions, understands billing issues, assigns tasks, orders the varnish, and maintains supplies.

-Divide tasks among staff to avoid time burdens for one person.

-Store supplies in exam rooms or in a portable kit.

-CPT code effective January 2015 for fluoride varnish application is 99188. It is suggested to append a Z modifier for preventive services (e.g. Prophylactic fluoride administration Z29.3).

-Update billing forms with varnish code(s).

-Have copies of educational handouts preprinted to give to parents.

what are some strategies for a successful office-based fluoride varnish program?

strongly promote breastfeeding, infants should be held while feeding, avoid propping bottle, fill bottle with only breast milk or formula

what are some dietary strategies for infants to educate families on?

establish regular meal times, limit snacks to once in morning once in afternoon, only give milk or water between meals, restrict fruit juice to 4 oz per day at regular meal times, avoid snacks with added sugar, prepare healthy snacks like cheese, fruit/veg

what are some dietary strategies for older children to educate families on?

Twice a day as soon as teeth emerge, bedtime is most critical d/t decreased saliva

Caregiver brushes child's teeth until age 8 or 9

· Small smear (grain of rice) if under 3, pea sized if 3 and over

· Stand or sit behind child, lift lip, brush along gumline, spit out after brushing

toothbrushing guidance to educate families on

Dietary changes

toothbrushing

Dietary fluoride supplementation if water source deficient

Establish a dental home

general ways to prevent caries to educate families on

Microbial imbalance in the mouth creates acid that damages the tooth enamel

The mother of a 9-month old patient asks what causes early childhood caries (ECC). Which of the following is the most accurate reply?

The majority of ECC results from thin or "weak" tooth enamel inherited from the parents

Microbial imbalance in the mouth creates acid that damages the tooth enamel

A lack of protective saliva is the most common cause of ECC

A calcium deficiency during tooth formation produces teeth that lack a sufficiently thick covering of enamel

Having existing white spots or calcifications

Which of the following factors places a child at the most risk for developing early childhood caries?

Having a diagnosis of asthma.

Living with family members who smoke tobacco

Breast feeding for less than than six months

Having existing white spots or calcifications

Both B and C are true

Which of the following is the major mechanism of action of topical fluoride in caries prevention?

It promotes saliva release which neutralizes acids on the tooth surface

It promotes remineralization of the teeth

It inhibits demineralization of the teeth

Both B and C are true

Fluoride varnish can reverse early decay and slow enamel destruction

Which of the following is a benefit of fluoride varnish?

Fluoride varnish permanently seals the pits and fissures of teeth

Fluoride varnish decreases the need for routine dental care

Fluoride varnish can reverse early decay and slow enamel destruction

Fluoride varnish replaces the need to take systemic fluoride supplements

Recommend to use only a small smear of fluoridated toothpaste when brushing the child's teeth

What guidance would you provide the mother of your 20-month-old patient who expresses concern about her child developing fluorosis? The family lives in a town that adds fluoride to the water supply and the child has already had two cavities.

Recommend to use only a small smear of fluoridated toothpaste when brushing the child's teeth

Recommend to use a non-fluoridated toothpaste

Recommend to brush the child's teeth every other day

Recommend to only give bottled drinking water to the child

All children under age 6

According to the U.S. Preventive Services Taskforce (USPSTF) recommendations, which children should receive fluoride varnish in the medical office?

All children at high risk for caries

High risk children without a dental home

Children at low risk for caries

All children under age 6

The gauze is used to dry the child's teeth

When applying fluoride varnish to an infant, what is the most important function of the gauze?

The gauze is the vehicle used to apply the fluoride varnish to the teeth

The gauze is used to hold the tongue out of the way

The gauze is used to dry the child's teeth

The gauze is shown to the child to stimulate her to open her mouth

Avoid giving the child hot, sticky, or hard foods for at least 6 hours

What guidance do you give the grandmother of a child who has just had fluoride varnish applied to his teeth?

The child's teeth will be discolored for about a week

Do not brush the child's teeth for at least 48 hours

Brush the child's teeth in about 1 hour

Avoid giving the child hot, sticky, or hard foods for at least 6 hours